Choice of IO scanner I

Updated: Nov 6, 2021

In my practice I used both the Trios3, Cerec Bluecam and Omnicam. I never got around to using Primescan in my own practice. But I have spent some time interviewing existing users, as well as doing some testing and examining Primescan at various trade shows and exhibitions.


My experience is based on Cerec in-house production from scan to design, mill, stain & glaze and cementing. Additionally on a 3Shape setup with a Trios3, design studio, VHF milling machine and ivoclar porcelain furnace. Also an in-house end-to-end workflow.

The clinic had a CBCT since 2008, as part of the digital workflow, including guided surgery. I have also been an international key opinion leader for KaVo for 9 years, in the field of digital workflows.



I imagine that with my experience of both systems and my insight into the digital workflows, I can contribute to a slightly more nuanced picture of what is good and what is bad. Compared to colleagues who make recommendations solely on the one system they know.


It is my hope that, after reading this and next week's post, you have a slightly more real opportunity to assess what is best for you.


The best scanners

First of all, I would like to state that, in my opinion, 3Shape and Dentsply Sirona deliver the best and most expensive scanners on the market at this moment (2021). They are nice and great, but can also be expensive investments if your needs are not very big. In that case, a Medit scanner might be a more affordable alternative.


Before investing in an IO scanner, you should spend some time thinking through - and paying attention to - the workflow you will be working with in your practice. Should it be a simple one in collaboration with an external laboratory? Or will you be working with in-house milled onlays, crowns, guided or navigated implantology and/or 3D printing?


In addition to my 2 favorite scanners (Trios and Primescan), I'll also touch a bit on the iTero, which I've looked at quite a bit in the last six months. So if you are going with considerations about this type of scanner, it might be worth reading along too.


The initial important choice - workflow

The very first decision you need to make before you start looking at an intraoral scanner is what workflow you want to pursue in the future. If you are 100% certain that you are going to exclusively send all of your scans to a lab, it almost doesn't matter which scanner (3Shape or Primescan) you choose.

Note: please read the whole text before ordering your scanner.


If you know you want to work more towards a 100% digital workflow there are basically 2 paths you can take:

  1. Prosthetic workflow

  2. Surgical workflow

It is not that one workflow or the other excludes the other. It's just important to consider what you're going to be doing the most of and what interests you the most. Because that should have a decisive influence on your choice of scanner. After all, there is a big difference between how easily one or the other workflow will work in practice. Especially the software you will be using to facilitate the entire workflow. In this regard, there is a huge difference in the integration of the scanners and the ease of use.


The prosthetic workflow

If you know you want to work towards an in-house prosthetic workflow, there's no doubt that Cerec is the way to go. They have spent over 40 years refining this technology and the workflow they are so famous for.


As I'll write about later, there are many cool and fancy software solutions at 3Shape. The problem is that they are not in any way reliable. So it has a huge impact on your clinic's profitability, your stress levels, your freedom and your job satisfaction if your equipment doesn't work as intended.


I have followed a number of very productive clinics online and seen how they have proudly proclaimed how they got IO scanners and milling equipment from Planmeca and 3Shape respectively. In everyone's case, the photos they show on their websites the following year say Cerec. I think that says a lot!


When we stand at the trade shows and look at all the neat features, it's easy to fall in love with 3Shape's software solutions. Like Planmeca's vision for the digital clinic is pretty brilliant. But when we're in the clinic and the crap doesn't work, we quickly find ourselves running late, having to cancel patients and spending time on support and technicians when the fancy solution doesn't work. It's insanely frustrating and EXTREMELY expensive.


I really don't want to decry 3shape's software solutions. It's just a known fact among 3Shape scanner owners that you should NEVER update your scanner software until at least 6 months after the release date. This alone says a lot. Please bear in mind that the 3Shape scanners are excellent. My experience with the all the cool additional 3Shape software is unfortunately that you will feel like a beta tester. Even though you have payed a pretty hefty price for a piece of software, that you would expect working seamlessly taking the price into consideration.


The surgical workflow

While Cerec is the only system that really works in practice when it comes to the prosthetic workflow (this will probably change in the future), it is completely different when we look at the surgical workflow.

Here, it is clearly Nobel Biocare that has been the leader for all these years. They were among the first to develop usable software and clinical protocols for guided surgery. Nobel Clinician and Nobel Guide, are state of the art.


When Nobel Biocare was acquired and integrated into the Envista group, a lot of resources were put into creating the software platform of the future for digital imaging. They have developed the DTX software platform, which is uniquely amazing - on the drawing board. If you fall in love with the software and all the brilliant ideas behind it, you should know that at the time of publishing this blog, the software is not yet fully developed for all areas.


DTX

DTX is distinguished by being an open platform. So you can use any IO scan in STL format in the software. Which means you can use a Primescan if you want. It's just not directly integrated into the software. Where the idea is that you should be able to use your Trios scanner, Medit Scanner or any other scanner and scan directly into DTX. Just like your CBCT scanner also sends its DICOM data directly into DTX. Is there no immediate prospect that you will be able to do the same with IO scan from a Primescan. Which means that with Primescan you have to export STL files and then import them into DTX.


You may not find this to be a problem. After all, that's really the way we've always done it. At least those of us who couldn't wait for the technology to mature enough. We have learned to live with cumbersome workflows that were not intuitive and required several workarounds to work.


Frankly, it's just more time-consuming and tedious than if it all ran over one software platform, on one intuitive interface.


Where DTX works, and is actually very superior to the alternatives, is on the surgical planning and lab side. The way you can work with CBCT and IO scan - first in the clinic and then in collaboration with the lab that you use for the subsequent prosthetic reconstruction - is absolutely outstanding.


I know I'm going to appear somewhat ecstatic here and in that context I'd like to remind you that for 9 years I was the international key opinion leader on digital workflows for KaVo (and thus indirectly for DTX), which means that I know about many of the ideas, techniques and future projects associated with DTX.


In-house prosthetics workflow will surely come one day. But right now, there's no way I'd use DTX for that. But for the surgical workflow and the integration between CBCT and IO scan, DTX is uniquely good.


Guided surgery

DTX introduces some artificial intelligence that designs your surgical guides. You can export the corresponding STL file directly to a 3D printer and print your surgical guide yourself. Just like you can export your surgical project to X-nav and do navigated surgery, which is a pretty cool technology I'm not going to describe in this post. DTX can be used for the simplest of single tooth procedures, as well as the most complex projects with completely or partially edentulous patients.


Cerec makes it possible to produce milled surgical guides on their largest in-house milling machines, with a pretty significant limit on the number of fixtures you can insert. The latest I've heard is that you can now also export larger projects in STL to your 3D printer. However, I haven't had the opportunity to validate this yet.


DTX is better integrated with Trios (and Medit) than other IO scanners. When it comes to Cerec's digital workflow for surgery, it is much much more time consuming and cumbersome to work with than DTX.


Surgery or restorative dentistry

The vast majority of clinics are oriented towards fixed prosthetics. Where it remains a relatively small niche that specialises in implant surgery. Therefore, a Primescan would immediately be an obvious choice for most clinics. In particular those clinics that want to work with in-house workflows.


Clear Aligners

When we talk about niches in dental treatment, it is difficult not to get around the most complex treatments we can perform as dentists. Namely orthodontic treatments. Here, orthodontics with clear aligners has gained more and more ground in recent years.


In Europe the Trios3 is still compatible with Invisalign. However it seems obvious that Invisalign is trying to get rid of all other scanners than their own iTero. I will be describing how the iTero is the best for Invisalign but really inferior when it comes to everything else.


ClearCorrect, Sure Smile and Spark are all excellent alternatives to Invisalign and even though their software solutions do not yet match Invisaligns. I believe it is only a matter of short time, before the competitors have closed the gap. When this happens, it becomes increasingly difficult to argue why you would want an iTero.


I know Invisalign purchased Exocad. This indicates Invisalign wants to add restorative dentistry to their portfolio. If they pursue the closed workflow as they are currently doing. I think it is worth looking towards Dentsply Sirona, who have decided to open all their platforms instead of working with a closed platform. Now Dentsply Sirona has more experience than any other premium provider of dental equipment on the planet in regards to offering closed digital workflows. If they have decided to open their software to other systems, to me that indicates they have had to face the problems associated with closed digital workflows.


Therefore I would be very cautious buying an iTero - unless my practice was large enough to justify 2 scanners. If the practice produces 100+ Invisalign cases or more annually, it may be a good idea to look at an iTero as scanner number 2. However it depends on the other tasks the scanner should be used for and how much flexibility the practice wants to have in its daily workflows.